Posted by yxibow on May 21, 2009, at 5:40:49
In reply to Re: Seroquel help needed! - yxibow, posted by ricker on May 21, 2009, at 0:01:37
> Thanks Jay, I appreciate your input and will take 50 mg. tonight. I am taking it for BP but I'm not sure if I'll get any stabilizing at 50mg, sleep should be okay so I guess it will be a trial. I'm also taking lamictal and zoloft along with clonazepam.
> The jaw clenching is actually quite painful but I did not know it was associated with eps, thought it was from the increased irritability?
> Again, thank you for sharing your knowledge,
>
> Regards, Rick
>Its hard to sort out whether its due to increased irritability -- bruxism is associated with anxiety disorders.
At 25-50mg of Seroquel, which is typical for off label use for sleep, there is very little if any appreciable antipsychotic activity in an average adult.
Combined with the Zoloft, it is rare, but possible that the slight D2 activity of Zoloft and an AP may increase EPS. But that's only an anecdotal thing that I have heard of.
There is always a risk of increased EPS with an SSRI and an AP, on the other hand the benefit usually outweighs the risks for the typical situations when they are combined, such as hard to treat OCD.
I can appreciate that bruxism is painful -- I have had it before, and though I have a neurological/psychological tic in my mouth now, which can be and is painful, the sensation would be different with jaw clenching which would feel more like TMJ and even extending up to the ear line in some serious cases.
As for NMS, it is a very rare condition -- so rare that at that level of medication it is nearly a non issue. NMS involves more than just jaw clenching -- delirium, high temperature -- similar to SS (serotonin syndrome) in a way, which is also rare and in that situation the patient is unfortunately sometimes almost unaware of SS.
Have you tried or asked your doctor for extra clonazepam to see if it calms the bruxism ?Also, a small trial of Artane or Cogentin (unfortunately they dumped Akineton from the market, alas, anyhow...) (anticholinergics) might shed some light on whether it is a form of EPS or can control the condition. Artane is a bit less of a sledgehammer in my opinion.
I'm not trying to dismiss any possibilities that Seroquel may not be right for you -- as I said, small augmentations of Zyprexa, even Abilify might be possibilities.
One study quoted the one year risk of TD with Zyprexa to be about 0.5%, and I would say that in general low potency atypicals would probably be similar. Risperdal has been shown to have some higher risks. But then again, these are tardive (late) phenomenons -- in general atypicals have been shown to have about 1/5 the risk of old generation APs.(The British Journal of Psychiatry, Jan 1999; 174: 23 - 30.)
Also, just curious, how much Lamictal are you taking ? I'm not questioning your doctor's judgment but Lamictal alone could stabilize some types of BP. On the other hand, I know of someone who is on a pretty high dose of Lamictal along with Seroquel and has some BP spectrum condition.
Among the panoply of things I also do take Lamictal -- it by itself can be an antidepressant, or at least an augmentator. It can be good in stabilizing suicidal thoughts.
-- tidingsJay
poster:yxibow
thread:896829
URL: http://www.dr-bob.org/babble/20090515/msgs/896938.html